By Bill Bowman, JD, Stacy Mecham, MEd, and Brian Gibbs, PhD

AlphaImpactRx has collaborated with Oncology Business Review to generate the latest installment of our annual year-end review of the personal promotional landscape in oncology. This overview of promotional trends will be supplemented with insights into the approaches companies are undertaking to maximize the value of their sales representatives.

The biopharmaceutical industry faces increasing challenges in marketing its products, due to various forces that include restricted access for sales representatives, heightened scrutiny from regulators, and concerns from payers over the escalating costs of specialty drugs. As drug manufacturers face pressure to lower costs, many have reduced the size of their sales forces, such that the number of active pharmaceutical sales representatives industrywide reached a historic low in 2014.¹ Companies must decide how to most effectively deploy their sales representatives, to not only call on the most high-value physician targets, but also to deliver the most effective messages in a manner that drives treatment choice.

Perhaps no other aspect of the industry has been more affected by these trends than oncology. On the one hand, an unprecedented number of new product approvals have occurred over the past few years—in 2014 alone, a total of 11 new molecular entities (NMEs) were approved by the FDA for treating cancer.² And on the other hand, a growing number of oncology practices are consolidating, or closing their practices to join larger groups or hospital-based networks.³ Moreover, nearly two-thirds of practicing oncologists—the highest level among all specialties—report having some form of restrictions on access by sales representatives.4 As a result, oncology sales representatives have the challenge of obtaining “face time” with physicians, followed by fundamentally understanding their customers’ needs and ultimately, delivering the message(s) that will have the greatest impact in driving brand choice. In this environment, optimizing field force deployment and promotional effectiveness become especially critical.

Share of Attention

Figure 1 illustrates how the oncology promotional landscape has become an increasingly crowded marketplace. Overall, oncologists reported obtaining fewer total details over time, even though the number of new cancer products expanded, and existing brands received additional indications. This plethora of products resulted in heightened competition for share-of-attention and will likely continue as new products come to market.

The graphic points out two parallel trends involving personal promotion of oncology brands: (1) the total number of reported details continues to decrease, and (2) competition for face time has become increasingly fierce as more players and brands have entered the market. In 2014, companies with larger and/or growing shares have tended to be those with multi-brand portfolios, as well as those with new product launches or line extensions for existing brands.

For example, Genentech has widened its leadership position, owing in part to new indications in 2014 for its flagship brand Avastin (cervical cancer and ovarian cancer) and for Perjeta in neoadjuvant treatment of HER2+ breast cancer during the latter part of 2013

Celgene has maintained a relatively high share of voice as Revlimid faces new competition in the NHL space from new players such as Janssen/Pharmacyclics (Imbruvica) and Gilead (Zydelig)

Likewise, BMS has held its solid position, even as key brands have seen additional competition (e.g., Yervoy in melanoma). The year-end approval of Opdivo bodes well for the company in 2015

In January 2015, Opdivo was number 1 among all brands detailed to oncologists

Lilly's position has been strengthened by the launch of Cyramza, first for gastric cancer and later for non-small cell lung cancer

Driven by its assets in melanoma, GSK experienced a modest uptick in 2014 as it prepares to divest its marketed oncology brands to Novartis this year.

Top Promoted Brands in 2014

Many of the top promoted brands in 2014 were either recently approved, or were for existing products that gained additional indications within the past year. Several tumor markets have become especially competitive, including CLL, multiple myeloma, and non-small cell lung cancer (Table 1).

Table 1. Top 25 Brands Promoted by Sales Representatives in 2014

Imbruvica skyrocketed to first place in 2014, following its first approval for mantle cell lymphoma in November 2013, followed by a second indication for CLL in February 2014. It is co-promoted by Janssen and Pharmacyclics.

Afinitor (Novartis) ran a close second, and has been actively promoted for its indications in HR+ metastatic breast cancer, as well as for renal cell carcinoma

The perennial blockbuster Avastin (Genentech) inched up to the third position, owing in part to new indications for cervical cancer and ovarian cancer

Several brands in the fiercely competitive multiple myeloma space ranked one after the other in order – Takeda’s Velcade was 9th, with Celgene’s Revlimid and Pomalyst coming in at 10th and 11th respectively, followed by Kyprolis (Onyx) in 12th place

Increased Vectibix activity on the part of Amgen propelled this brand from 37th to 13th place, perhaps owing to the indication for 1st line KRAS mutation positive metastatic colorectal cancer.

Measuring Performance of Sales Reps

As the oncology landscape evolves, methods for measuring the performance of sales representatives are shifting from an emphasis on attaining revenue targets alone toward an approach based on customer satisfaction.5 This new approach can take into account various parameters of quality regarding the representative and the message(s) delivered, including reps’ ability to connect with customers and deliver messages in a relevant and compelling manner.

Tables 2 and 3 show the companies that received consistently high scores on performance measures based on compelling and relevance. Sales organizations in some of the larger companies with a long-standing presence in oncology scored very well. Yet, several smaller organizations that are relatively new to oncology received high ratings, which indicate that perceptions of quality involve factors other than company size and industry tenure.

Table 2. Rep Quality Ranking: Compelling in a Positive Way

Table 3. Relevance to Practice and Patients

Promotional Effectiveness Outcomes

As oncology marketers deal with these challenges (restrictions on access, understanding customers in a changing environment and delivering relevant messages that help drive treatment choice) they must also decide how to most effectively deploy their sales organizations. Determining a sustainable sales model in oncology is a vast undertaking as the marketplace becomes more complex. Various models have been developed that take into account factors, such as the size of the overall field organization, the number of indications per brand, the number of brands in the oncology portfolio, and any co-promotion agreements.

When launching a new brand or indication, all companies must decide whether the brand/indication will be promoted alone or with another existing brand/indication. If the new brand/indication will be promoted alongside an existing product, teams must consider the detail position for the new launch, how long to employ the promotional strategy and, perhaps, most importantly, to gauge how the new launch will affect share for the existing brand.

To shed some light into possible promotional effectiveness outcomes for in-market products we evaluated two common scenarios:

Single Indication to Multi-Indication Sales Strategy—sales teams move from promoting one brand with a singular indication to promoting two indications for the same brand

Single Product to Multi-Product Sales Strategy—sales teams move from promoting one brand to promoting two brands with different indications

Response models were developed using an adstocking approach that incorporates the history of physician exposure to all detailing by all brands in each market, and estimated using a multi-nominal logit estimation approach. Controls were introduced for patient characteristics, physician’s perceptions of these detailing efforts (content, quality), tactics, and messages. Results showed that the impact on the in-market product were dramatically different.

For the “Single Indication to Multi-Indication” model, we found that the launch of the new indication breathed life into the in-market indication (see left side of Figure 2). That is, details for the in-market indication became more effective during early launch for the new indication, but quickly dissipated. This is a highly likely outcome if new information for a new indication leads to the reconsideration of the features of an in-market indication, and willingness to re-engage in a conversation about it in that market. This is an enviable outcome for an in-market indication that is in the mid to later stages of its lifecycle.

For the “Single Product to Multi-Product” model, the results showed that the launch of a new product significantly altered the trajectory of the in-market brand’s detail effectiveness. That is, details for the in-market product that had been effective prior to the new product launch were ineffective during early launch, but returned to its prior level later in the launch. Marketers should consider this potential outcome, and consider ways to optimize messaging and sales strategy for in-line brands during the early launch of a new product in their respective portfolio.

Determining the right promotional strategy is critical for the success of the new product/indication launch as well as the existing brand

Using extensive information about every launch brand’s promotional effectiveness since 2002 as well as impact on exiting in-market products, AlphaImpactRx helps the pharmaceutical and bio-pharmaceutical industries determine the impact of likely promotional strategy alternatives including insights on detail position, execution tactics, messaging and targeting.

AlphaImpactRx is the leading provider of primary research-based insights, analytics and solutions to biopharmaceutical, consumer health and medical device companies. Through the combination of its consulting expertise, innovative technology, proprietary physician panels and syndicated data assets, AlphaImpactRx provides market research to help its global healthcare clients make informed and timely business decisions to develop and market their products. BrandImpact® is a proprietary product covering multiple specialties that uses an i-enabled software platform that collects detailed information at the point of engagement for both representative visits and patient treatment. BrandImpact data capture not only treatment decisions in response to promotion, but also the attitudes, perceptions and beliefs underlying those decisions. Our Oncology panel has 425 physicians and was built to align with clients’ target lists. AlphaImpactRx also has a Promotional Response Practice that leverages our longitudinal and normative data assets with advanced analytics, to empower clients in improving brand performance by making more informed and effective decisions with respect to marketing strategy, message execution and field force deployment.